GW1--02526_Well Construction - GW1_20240423

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- • 'KNELL CONSTReC LON RECORD Fur � i trs,ttvLY:
'' This form can be used far single ow multipk wctls• . - •
• it.Welt ContractorIufonnatlon: ' ; '
ea:AVat tRl©Nt
- Brian•Ewing- - . ' • . - FROM. TO ' • utaS,4utPTlON . ' '
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well CoMru lorNaiw.- • fe: • R.
4240-B R. fr. ! I.
NC Weil ComractarCcnificnliortNuiuber •• "t5'ODTER'CASING'ifoi~'dustI-€nwil wcth)OR LINER'(f ni-llcabk1 E .
-- - _ - ••FROM_ i<B TODIAMETER" TFnQiQ�EGr h1ATEntAI.'
SAEDACCO • . . ft., fL' ta; . .
Company Nonce, ' ;,e6:i1VNER.CASING'ORTUB c itiermafeoiett4o6"i :
- - FROM 'TO DIAMETER' TIiiCKNESS MATERIAL
2.�Ycl1 Constrvctuin Fernlit#; 0 ' 'R. 15 ft, 2° - 1 ' mL SCH-40 ' PVC '
fist allapiaNcrahlc Purl%peniri s(i.c:,County..S)atc,d'uriaore,Ir•Irs-tryi ra:)
-R. fr. ' -n.
• 3.Wc11 ltsa(Cheek Weft aSg):' _e7ZSCRLEPI'
Watcr Supply Well• • -- mom• • .TO DIAMFTIIR sun-sin: - T1ItCiLN s MATERIAL'
ChAgticttitiuul• , . CJMpnicipaliPubhc; • 15 ft. 25 ft. 2° it 010 SCH •40 PVC
. EIGcotltennal(T3eating, oolingSupply) OResidential Water.Supply-(siogle) R. if. ilr .
t]lndustiialiConmtercial lJResidential WaterSupplg(slrited). TtriGROU'r' .
FROM -TO. • MATERIAL -EMPIACEMENT•ME1110D S A-11QUNT •
•❑lliipaation . . 0 ft. 'li ft:'. PORTLAND TREMIE
Non-Water Su1Hlty Weil: • R.
- •RlMonitoring : ❑Rccovery . .
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Injection h. • -ft.• .
DAttuifcrRccharge IJGmttridn:Itcr Rcittcdiation ' 19 SAND1GRAVEf 1'ACKfir utiplteitidt-r --.
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- FROM - TO • NINO-It/AL • RA :PE( 1_MENTM13ilOn
I]Aquifer.Stoni$Gand Rccgvrcy' ❑Salinity Harder- 13 R. 25 It. FILTER SAND # 2
. ❑AquifcrTcsf• • • . - • EIStounsntcr D1:tittogg, '.
'tr. R.
❑Eyiciimcniall hnotogy. DSnbsidcfcc•,Coniiul'
20 DRILLING LOG'(aitach additional sheets if uccccsan•T. -- ,
DGtltennt1(Closed Loop) - gTrac'et ...FROM, TO' DESCRIPTION Color,uantncsi.soil4aektatre:'r aasire.da1' -
❑GeotltenniaL(14eatineiCooliug Return). . ❑Oilier(explain under#21 Retuat.ss) 0 .:ft, 5 fL. FILL''SILT CLAY •
5 IL. •15 •- ft. MOIST-TO WET SILT/ CLAY • '
4 Date Welt(s)Conlplcted: 2-14-24 _welt iDittaw-H3-02• 15 (t•, 25 fG MOIST SILTY SAND(`_. "_-',`1..;-.. ,
3a.N4d1 Lueation: , . .rt. _ •tt. t -t-- l .r tr �.,
. Chemours . ft. ' . D. n
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A ': 202
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Facilit,,p,,,:ii Nutae . Facility ID?i(ifapplieublet R. fi.- I
986 Buckle.Rd., Currie, NC,- 28435 • ft. E.MC,i,
Physical AddresS,•City.unitZip •'3t:REMAItKS.. . .
Pender • BENTONITE SEAL 11 TO13' •
. . 'Comity • , Parcel Itleritifeatioallo,(PIN) • . . ! - ' . .
• . ab.,Eatitudeand IAr gitadcinilcgrccstmittutest&ccundsorticcirtia'drgnccsr 27 c.roe Ieati,- . ;. - - .
' • (Ifni:ll9ktdptutc_la1letigiSsr4flcknt} ��D •
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_ ]� - . W - ._ Br.-1an�-..Erb i n.g •
- .- - 2/2/2024
' Siame-et fCenificd Well Contrator:, Dale
6.Is(are);the-Wcll((s): 111I a rtiiameut or .DTetnpora11'-.. 1 frerebr•a.ri :dog rhr mr i s wr r krn)•cpnrinreted air rutronlancr •
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rt}:ignbrs shay funn. !y:dog 7(9 {
' with 1 A NVCAC 02C.0100 or 15d NCrtC(12C.,0200 wirteonstraeikm Srarufards and:,, a
• . 7.'Is thi't a ri.p:lir to an csihting•%ve1l:. DYcc or KIND. .raps ofrliec reran-I/wa'(,.is aforkfort ibahc tall Daher, '
• if this:is a rerarlr;fall witknauvi writ eonorrirctloia brfaruirrlon inn/rcr'rairi the main' afrbe •' '
irliairraafer r41 rrrnierL•i•srctiurr or-on.rho bOrk.nfen.farm.. - ' - 23:SitediairamoradtlitionalWel1,dCt11iig: '- • -
•- •You ivay use the.bacl;of this page to provide additional well site details:or%sell, • '
' S.Number of Was,constructed: 1 construction delaits:You rosy also:illacli additional pages if uecessa13
.Poi inn'lank li>feerlvnorrirur-neutersupp1 a O'sONL1'OratlhesanecurtsleucUou coon can,
Submit one form, •SUahf MTTAL iNSTtTC.TIONS'• . --
9.Total welt depth below land surface: '25 ((h;j •21a. Par•All Wells:. -Submit this•Tonal%i'itliin 36 da}'s Of completion of welt.
For manure forllslist nil dtp asifdit,rearrfesnaipr,3@200-iuul2o1(N0'1 constnlctianto the:foltoning; ;
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• 10.Static Water levethelow top Of casings .. • . -- - - (ft.). - .Division of Water R I oiircen,fnfotmattan Processing Unit,.
If pryer-47i'f is aura casin,;;use"+" . • 1617 Mail Service1CeInter.ILileigh,NC-27699-1617 . '
el.Itorelmte diatneten 8.25" (tu.) ' 24ta.Far Injection Wetps ONLY: Tit addition to.sending the fonts to the address•in
24a•aboite.also submit it-copy of this faint witttin 30'day's'of completion of well
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12,Well construction method:BORED • COIiSUUttiou to die folloWic1_g_.
(i.e.pugcr;ro y.cable dia*1;ask etc) . . - . 1
• • 'Divitlou of Water Resources,Tbudevgrouud Gtjection Control Program,
' FOR WATER SUPPLY WELLS ONLY:' - •1636 Mail Serviceit l ntcr• ,Raleigh,NC 27699-1636 -
i3a, cell(1Tpm} 74e.For.Water Supply&laljection Wells: •
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�Icthod oftczY:_ _ Also submit one copy'of this:form within 30 days of completion of
I3b.Disinfection.gv'pet. • Amount: - well construction to the.county health deportment of the coiinly when:-
constnicted. I
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Font'GW-L. ' NonitCaraIintf). rictem of'Environment att.(1 Nato eatRcourccs—Dii3s loll of Water*clines Revised August 10I3
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